Pediatric Nurse Exam Pediatric Nurse Psychosocial and Mental Health 3 — Questions and Answers
Question 1: A 7-year-old child with ADHD is starting methylphenidate. The nurse should monitor for which common side effect?
- Weight gain and increased appetite
- Decreased appetite and insomnia (Correct answer)
- Bradycardia and hypotension
- Increased sedation during school hours
Correct answer: Decreased appetite and insomnia
Stimulant medications like methylphenidate commonly cause appetite suppression and sleep disturbances in children.
Question 2: A nurse notices bruising in various stages of healing on a 5-year-old's back and buttocks. The most appropriate first action is:
- Ask the child's sibling what happened
- Document findings and report suspected abuse per protocol (Correct answer)
- Confront the parents directly about the injuries
- Apply ice and continue the assessment
Correct answer: Document findings and report suspected abuse per protocol
Bruising in unusual locations at multiple healing stages is a red flag for abuse; mandatory reporting is required before confronting caregivers.
Question 3: The nurse is assessing a 2-year-old for autism spectrum disorder (ASD). Which finding would be MOST concerning?
- Parallel play with peers
- Lack of pointing to share interest with others by 12 months (Correct answer)
- Preference for a particular toy
- Brief tantrums when a routine changes
Correct answer: Lack of pointing to share interest with others by 12 months
Absent joint attention behaviors such as pointing by 12 months is a key early red flag for autism spectrum disorder.
Question 4: Which therapeutic communication technique is MOST appropriate when a grieving adolescent says, 'I don't want to talk about my dad dying'?
- Encourage them to express their feelings immediately
- Acknowledge their statement and offer to be available when they are ready (Correct answer)
- Change the subject to reduce their distress
- Explain that talking will help them feel better
Correct answer: Acknowledge their statement and offer to be available when they are ready
Respecting the adolescent's readiness while conveying availability maintains trust and does not force premature disclosure.
Question 5: A nurse is educating parents about oppositional defiant disorder (ODD). Which parenting strategy should be emphasized?
- Strict punitive discipline to establish authority
- Consistent, predictable boundaries with positive reinforcement for compliance (Correct answer)
- Allowing the child to set their own rules to reduce conflict
- Ignoring all negative behaviors without any response
Correct answer: Consistent, predictable boundaries with positive reinforcement for compliance
Consistent structure with positive reinforcement is the cornerstone of behavioral management for children with ODD.
Question 6: A 13-year-old with depression is prescribed sertraline. Which finding requires the nurse to contact the prescriber immediately?
- Mild nausea during the first week
- New onset of agitation and increased talk of death (Correct answer)
- Difficulty falling asleep in the first two weeks
- Headache reported on the second day
Correct answer: New onset of agitation and increased talk of death
SSRIs carry a black box warning for increased suicidal ideation in pediatric patients; new agitation and talk of death require urgent evaluation.
Question 7: During a well-child visit, a mother reports her 18-month-old still has not said any recognizable words. The nurse's best response is:
- Reassure the mother that boys often talk later
- Refer the child for a comprehensive hearing and developmental evaluation (Correct answer)
- Advise the mother to read to the child more often
- Schedule a recheck in six months before acting
Correct answer: Refer the child for a comprehensive hearing and developmental evaluation
Absence of any words by 18 months warrants immediate evaluation for hearing loss and developmental delay rather than watchful waiting.
Pediatric Nurse Exam Pediatric Nurse Psychosocial and Mental Health 3
A 7-year-old child with ADHD is starting methylphenidate.
The nurse should monitor for which common side effect?